Healthcare Provider Details

I. General information

NPI: 1144284803
Provider Name (Legal Business Name): ERIC RAYMOND FRIZZELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 REGIONAL DRIVE
PINEHURST NC
28374-8850
US

IV. Provider business mailing address

205 PAGE ROAD
PINEHURST NC
28374-8798
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-9207
  • Fax: 910-235-3432
Mailing address:
  • Phone: 910-295-5511
  • Fax: 910-235-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD31751
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2006-01095
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: